CARDFLEX, INC.-2012 - Laserfiche WebLink

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OFFICE: REP: Emma Baillie ACH Processing Application I MID SIC: r r v L i2 ® ACH Processing Program-(SFTP) Virtual Ternlnal (a) Manually kay data Into VMual Terninal, or b Upload comma separated values (CS tee into Virtual terminal _..+ t-.°�!3' - . .BPISINESB(NF6RMATfONi;."`.r..,.�.,;^�' .., ... ".. eg ame'G.Ity of Santa Ana °"e 714 540-9737 Loceaons: 1 A ° g Clty of Santa Ana Contact era°"Christine Duarte Business As). •r omi`a20 Civic Center Plaza Email ddress.cduarte@santa-ana.org Addreross: C"' Santa Ana state: CA P92701 DN ones 956000785 mpdyeee: -.:,... ACH)P:ROF.tEE .;c, . "a ¥&+r"=..,,' «r:ja% .. v-9. Corporate Credit or Debit Pre -arranged Payment and Deposits Telephone Initiated Entry Web Initiated Entry ❑ CCD Credit p CCD Debit D PPD Credit D PPD Debit D TEL Debit D WEB Debit Merchant's Average Items / Month #: _ _ _ - - Requested Maximum $ / Transaction $:_ ._ _- -- Activity AverageItem $: _ Limits $/Day $. _ Average Returns / Month #: .. _. $/ Month $: # Trans / Day #: # Trans / Month #: .-- ame(print): Tge: Equity/Ownershlp: % Date of Birth: Drivers License # State: Social Home Securit #: Phone: Home Address: City State: Zip 2) Name (print): This: Equity/Ownership: 'Y Date of Birth: Drivers License 3 State: Social Home Securit #: Phone: Home Address: ity State: Zip ¢ ,NK�REF,ERES Bank#1 Name. Account Number: Phone: Bank#2 Name: Account Number: Phone: r ._, t... BIJSINESS,PRf)FIIE '° t._ : ^ 'tx,.. , _ . ,777777,7777 Type of Ownership: D Sole Proprietor 0 Partnership ® Corporation (State of Incorp: _ _) ® Other Government Number of Years in Business 143 Length of Current Ownership: 143 Other currently/previously awned businesses: Prior Bankru toy? ® Yes ®No DateDischarged: ed: Do you currently accept Visa / p g MasterCard / Discover Network? ®Yes ®No (If yes, submit 3 most current statements) Currently Processing with EFT?: E7 Yes® No (If yes, name of current processor): Methods of Marketing: Detailed Description of Business License Products/Services Sold: " fEECHEOUIE '",,; .w':`t?x. m,t,x,. Item Fee: $ 0'25 and 0'25 e/ each Item Monthly Fee: $ 5'00 Setup Fee: $ 0.00 Monthly Minimum: $ 10.00 Inquiry Fee: $5.00 Gateway Fee: $ 0'00 Over Monthly Limit Surcharge: $0.10 +0.1 % File Load Fee: $0.50 / Batch Overdraft Fee: $25.00 each occurrence Returned Item Fee: $ 3'50 Late Returned Item Fee: $ 3'50 (Each rejected or corrected item) Excessive Return >1% Fee: $1.001 Rem Excessive Late Return >1011 Fee; $3.00/item ..S?iCtlORfX.�9'TIQNbTO;CREDI7 AN0 BI aB.CCOLNT .-±5 CLIENT hereby auftwrizes CaI in accerdarrce win the Data Processing and Payment Cdlecnon Agreement, to Iritlare dept and creciterrotes to CLIENTS business chaSdrg amount as indicated on bre enclosed voided check This athonty into remaininfill once and erect urtl (a) CardFlex has receivedwnsen notiosimtixm CLIENT of Its temin Sim in such merrier as to afford Cardi Iex reasonable oppors my to ad on It and (b) all orligations &CLIENT b Card oexthathave arisenurderatls Agreanenl havabeen padin fun, Including, but not natetllo, those obligations described N paregmph7ofthis Agreement This euhaiedon a derds to such emiesin said acaountocrog lease, rental orpurchaseagreements for soMvae moor In INVESTIGATIVE CONSUMER REPORT:An investigative orConwmer Repodwill be meds in mn niglionwith tlds application. Apgicantautlwrizes Cad9wr orarrycreditbreau oray credit repatng agency employed by Candli ANY AGENTS OF CamPextoinvaidgace the references gvan or my other sikernaHs ordab obtalnetlfronnCLIENT, arany of the under signed pnndpeis. WARRANTY: Each of the myrarablices above 118W �arereNewad appii and warrants that all irrfamanon Is trus ad correct Each undersigned! owiedofioar 0 CLIENT represents and wartent tl>at he has 'IleldmA mMarduderstendathe Dora Procassirgend Payment p. ry adwilhorrt nm�tlor thePmdecnsdf Pa'agreph 7, Incorporated bean by reference). Owner/GflICer Signature#1: Tone: Executive Director FMSA Date: -1/5 / Owner/Officer Signature #2: X Title: Interim CjLV Manager Dale; /w/ -0 1 .4L`L+CORR,9RATIONSc=:3Co ot'ate,.ResblrltiAn .a^"z '._, ." {"' ' _ E 7 The indicated office, identified above has the atinztion tto execute the Merchant Processl g Agreement win Bank and CFS on behaf of the here within named corporaton. Secretary of the Board: X btu. c 9-� Date;J' It^ p / Inc. ACCEPTANCE lCARDFLEX Application Approved By:Tttie: ___________ Date: / / Rev. 082012